Provider Demographics
NPI:1962678268
Name:KROHN, AUSTIN C (OD)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:C
Last Name:KROHN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3325 MAINE ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-4457
Mailing Address - Country:US
Mailing Address - Phone:217-231-3937
Mailing Address - Fax:217-231-3940
Practice Address - Street 1:3325 MAINE ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-4457
Practice Address - Country:US
Practice Address - Phone:217-231-3937
Practice Address - Fax:217-231-3940
Is Sole Proprietor?:No
Enumeration Date:2008-05-06
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007030965152W00000X
IL046010052152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO318758604Medicaid
IL046010052Medicaid